Postpartum Hemorrhage Flashcards
Define postpartum hemorrhage x3
Blood loss >= 500ml within 2hrs of vaginal delivery
Blood loss >= 1000ml within 24hrs of C-section
Any blood loss that affect maternal hemodynamic status
Define maternal mortality rate
The number of maternal deaths in a given period per population of women who are of reproductive age
Maternal mortality ratio
Number of maternal deaths per live births
Differentiate between primary and secondary PPH
Primary- within 24 hours
Secondary- from 24 hours up to 6 weeks
Uterus factors that control bleeding x3
Spiral arrangement of arteries
Hypercoagulable state
Increased prostaglandins
What are the 4 Ts of primary PPH
Trauma- genital tract
Tone- uterine atony
Tissue- retained products of conception
Thrombin- coagulopathy
Causes of secondary PPH
Uterine infection endometritis
Risk factors for uterine atony x5
Multiparity
Chorioamnionitis
Prolonged labor
Over distension of uterus
Labour induction or augmentation
Risk factors for trauma in PPH x5
- Forceps delivery
- Vigorous labor
- Episiotomy/laceration
- Removal or retained placenta
- Extra/intrauterine manipulation of fetus
Disorders of coagulation x4
HELLP
Von Willebrand disease
Dilutional coagulopathy
Idiopathic thrombocytopenic purpura
Clinical presentation of PPH x3
Heavy bleeding
Signs of shock
Enlarged uterus
Describe steps of AMTSL ie active management of third stage of labor in PPH prevention x5
Oxytocin 10IU after delivery
Controlled cord traction
Uterine massage
Regular and frequent assessment of uterine tone
Misoprostol
Initial steps on how to stop bleeding in PPH x2
Bimanual compression
Aortic compression
Management of PPH x6
Stop bleeding
Do ABC
IV fluids
Oxygen
Blood samples
Uterine massage
Management of uterine atony x5
Vigorous massage
Oxytocin 40IU in 1L IV
Misoprostol 800mcg sublingual
Tranexamic acid 1g IV stat
Examination under anesthesia
Surgical management of uterine atony x3
B lynch suture
Bilateral uterine artery ligation
Hysterectomy
Medication given when manually removing placenta x2
Pethidine 100mg IM
Ampicillin
Management of coagulopathy x4
Packed RBC
FFP
Platelets
Whole blood
Degrees of uterine inversion x4
1- inverted fundus up to cervix
2- inverted uterus body up to vulva
3- prolapse of inverted uterus out of vulva
4 - prolapse of inverted uterus and vagina out of vulva
When to suspect uterine inversion on bimanual examination x2
Uterine corpus not felt
Firm mass below or near the cervix
Immediate complication of PPH x5
Anemia
Hypovolemic shock
Acute renal failure
Acute liver failure
Acute pulmonary edema
Obstetric cause of DIC x4
Placenta abruption
HELLP syndrome
Fetal death
Amniotic fluid embolism
Risk factor of uterine inversion x5
Fundal placenta
Short umbilical cord
Excessive traction
Abnormal placentation
Previous uterine inversion
Define Sheehan’s syndrome and what causes it
Postpartum hypopituitarism secondary to necrosis caused by drop in blood pressure in PPH
Complications/presentation of Sheehan’s syndrome x4
Agalactorrhea- cant breastfeed
Unable to resume regular menses
Hypothyroidism
Adrenal insufficiency
Types of uterine relaxants x4
MgSO4
Terbutaline
Nitroglycerin
Halogenated general anesthetics
Two procedures for uterine inversion
Huntington
Haultain
